• Johannes Björkman, Lasse Raatiniemi, Piritta Setälä, and Jouni Nurmi.
• FinnHEMS Research and Development Unit, Vantaa, Finland.
• Acta Anaesthesiol Scand. 2021 Jul 1; 65 (6): 816-823.

BackgroundThe value of shock-index has been demonstrated in hospital triage, but few studies have evaluated its prehospital use. The aim of our study was to evaluate the association between shock-index in prehospital critical care and short-term mortality.MethodsWe analyzed data from the national helicopter emergency medical services database and the Population Register Centre. The shock-index was calculated from the patients' first measured parameters. The primary outcome measure was 1- and 30-day mortality.ResultsA total of 22 433 patients were included. The 1-day mortality was 7.5% and 30-day mortality was 16%. The median shock-index was 0.68 (0.55/0.84) for survivors and 0.67 (0.49/0.93) for non-survivors (P = .316) at 30-days. Association between shock-index and mortality followed a U-shaped curve in trauma (shock-index < 0.5: odds ratio 2.5 [95% confidence interval 1.8-3.4], shock-index > 1.3: odds ratio 4.4 [2.7-7.2] at 30 days). Patients with neurological emergencies with a low shock-index had an increased risk of mortality (shock-index < 0.5: odds ratio 1.8 [1.5-2.3]) whereas patients treated after successful resuscitation from out-of-hospital cardiac arrest, a higher shock-index was associated with higher mortality (shock-index > 1.3: odds ratio 3.5 [2.3-5.4). The association was similar for all ages, but older patients had higher mortality in each shock-index category.ConclusionThe shock-index is associated with short time mortality in most critical patient categories in the prehospital setting. However, the marked overlap of shock-index in survivors and non-survivors in all patient categories limits its predictive value.© 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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